Organization Name: | BANNER HEALTH |
NPI Number: | 1205267549 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DENNIS DAHLEN (SR. VP FINANCE) |
Mailing Address: | 1345 A Paul Bunyan Rd Susanville |
State: | CA US |
Postal Code: | 961303159 |
Phone Number: | 5302522235 |
Fax Number: | 5302522241 |
NPI Enumeration Date: | 12/12/2013 |
NPI Last Update Date: | 04/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |